Investigating the relationship between physical activity and emotional wellbeing in young people

Transcription

1 South West Public Health Scientific Conference 2015 Investigating the relationship between physical activity and emotional wellbeing in young people Sarah Bell (NIHR Doctoral Research Fellow) Supervisors Rona Campbell and David Gunnell

2 Magnitude of the problem One in ten (10%) children in the UK aged between 5 and 16 years had a clinically diagnosable mental health problem 6% had a conduct disorder 4% had an emotional disorder 2% had a hyperkinetic disorder 1% had a less common disorder Rates rise with age More prevalent in boys (ONS survey 2004)

3 Impact of mental disorder in Lifecourse 5-15 year olds with mental disorder are three times as likely to have mental disorder in adulthood 75% of adult mental disorder starts before age 18 Conduct disorder predicts all adult psychiatric disorders Social outcomes Academic underachievement Exclusion from school Occupational failure Social relationship difficulties Intimate relationship breakdown Isolation Substance misuse problems Criminality young people Diverse consequences Physical ill-health Physical complaints Early death Major cause of ill-health in industrialised nations 23% of disease burden in the UK Economic burden Annual costs of emotional, conduct and hyperkinetic disorders among 5-15 year olds in the UK estimated at 1.58 billion and the long-term costs 2.35 billion Overall, mental illness costs billion per year in UK (4.4% of Gross Domestic Product)

4 The wellbeing agenda Foresight Report (2008) Achieving a small change in the average level of wellbeing across the population would produce a large decrease in the percentage with mental disorder, and also the percentage who have sub-clinical disorder (those languishing ) Rose hypothesis (1992) Five ways to wellbeing (2008) Wellbeing in schools Every Child Matters (2003) National Health Schools Programme SEAL programme (2005) Ofsted Healthy minds (2005) Ofsted indicators (2008) NICE guidance (2008, 2009 updated 2012) PSHE curriculum Population approach

5 Policy background Healthy lives, healthy people Public Mental Health Priorities: Investing in the Evidence (CMO annual report 2014) Public Mental Health WHO framework WHO framework Wellbeing?

6 Emotional wellbeing Not merely the absence of mental ill-health but a positive sense of wellbeing which enables an individual to be able to function in society and meet the demands of everyday life.

7 Protective factors Physical activity? Any bodily movement produced by skeletal muscles that results in energy expenditure above resting level. Caspersen et al (1985)

8 To explore the relationship between physical activity and emotional wellbeing in young people 1. To systematically review the existing evidence on the relationship Objectives 3. To investigate the mechanisms underpinning any relationship 2. To explore young peoples understanding of emotional wellbeing and the factors they think may enhance or diminish emotional wellbeing in people their age, including the role of physical activity 4. To determine whether physical activity is a protective factor for emotional wellbeing 5. To investigate any doseresponse relationship

9 Study design and measures Prospective cohort from AHEAD trial participants (n=1000) Exposure Physical baseline (12-13 years) Measured used accelerometers Outcome Emotional follow-up (15-16 years) Measured using self-report Activity volume (mean daily counts per minute) Warwick Edinburgh Mental Wellbeing Scale (WEMWBS overall score) Moderate to Vigorous Physical Activity (mean daily MVPA minutes) Strengths and Difficulties Questionnaire (SDQ TDS) 1. Emotional symptoms 2. Conduct problems Evenson et al (2008) cut-points to determine time spent in physical activity of different intensities 3. Hyperactivity/inattention 4. Peer relationship problems 5. Pro-social behaviour

10 WEMWBS and SDQ

11 Potential confounders group for regression models Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Gender, age and intervention arm of the AHEAD trial Sociological factors: Model 1 + ethnic group, SES, study school *Study school treated as a fixed effect due to small number of schools (n=6) Physical activity factors: Model 1 + daylight minutes, wear time* Lifestyle factors: Model 1 + sleep, smoke, friends, belonging, drink Baseline wellbeing: Model 1+ emotional wellbeing at baseline (dependent on outcome, WEMWBS not adjusted for at baseline) Fully adjusted model Model 1+ ethnic group, SES, study school, daylight minutes, wear time*, sleep, smoke, friends, belonging, drink, emotional wellbeing at baseline

12 Study profile for the cohort Selected sample 928 pupils 6 secondary schools Year 8 pupils on roll (12-13 year olds) Response rate 99% (915/928) Baseline data 794 pupils (87%) Pupils providing complete, valid data at baseline 134 pupils excluded at baseline Study sample 673 pupils (74%) Pupils providing complete, valid data at baseline and follow-up 121 pupils excluded at follow-up Modelling Participant numbers vary between models based on completeness of data on outcomes and confounders Missing data for confounder variables

13 Descriptive results Descriptive results (mean (SD) values) n=673 Activity volume (mean cpm overall) (169.42) Boys (174.35) Girls (153.25) Mean daily MVPA (minutes) (21.47) Boys (22.07) Girls (19.24) WEMWBS (overall score) (8.66) Boys (7.99) Girls (8.90) SDQ (SDQ TDS) (5.56) Boys (5.73) Girls (5.36)

14 Regression analysis β, 95% CI, p-value n* Activity volume (mean cpm) MVPA (mean daily minutes) Co-primary outcomes Unadjusted Adjusted Unadjusted Adjusted WEMWBS overall score (-0.16 to 0.65) p= (-0.44 to 0.40) p= (-1.00 to 2.86) p= (-1.98 to 2.05) p=0.97 SDQ TDS (-0.32 to 0.22) p= (-0.41 to 0.09) p= (-1.79 to 0.74) p= (-1.94 to 0.43) p=0.21 No association between physical activity and emotional wellbeing overall or by gender

15 Regression analysis β, 95% CI, p-value SDQ subscales Emotional problems n* Activity volume (mean cpm) MVPA (mean daily minutes) Unadjusted Adjusted Unadjusted Adjusted (-0.37 to -0.13) p< (-0.23 to -0.00) p= (-1.75 to -0.63) p< (-1.02 to 0.04) p=0.07 Conduct problems (0.01 to 0.18) p= (-0.10 to 0.60) p= (-0.06 to 0.74) p= (-0.57 to 0.21) p=0.36 Hyperactivity (0.02 to 0.26) p= (-0.09 to 0.14) p= (0.03 to 1.13) p= (-0.36 to 0.72) p=0.52 Peer problems (-0.09 to 0.06) p= (-0.09 to 0.05) p= (-0.49 to 0.20) p= (-0.51 to 0.19) p=0.36 Prosocial behaviour (-0.19 to 0.00) p= (0.00 to 0.19) p= (-0.82 to 0.08) p= (0.13 to 1.02) p=0.01 Association between physical activity volume and SDQ emotional problems subscale

16 Discussion Evidence only for an association between activity volume and the SDQ emotional problems subscale Strengths of study Novel approach Large cohort Longitudinal design Accelerometry WEMWBS and SDQ Future? Clarity in definitions and measurement Core outcomes set How wellbeing and mental disorder are related Psychometrics Increase the evidence base for wellbeing Use the WHO framework Curvilinear relationship Mechanisms Wellbeing in schools!

17 Acknowledgements Thanks to schools and participants of the AHEAD study Supervisors Rona Campbell and David Gunnell Ashley Cooper NIHR Decipher The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged

18 Background-more details Area in infancy-vast and complex PMH evolving concept in public health-difficulties and much debate Issues: Terminology unclear and overlappingcontested boundaries (mental health, mental health problems, wellbeing/wellbeing, mental illness, resilience, emotional and behavioural problems, mental capacity, quality of life)- common ground between positive mental health and wellbeing and mental illness Measurement (What we trying to measure? Which scales to use? Proxy measures? Continuum?) Quality of the evidence (organisations/grey literature, other disciplines, 5 ways to wellbeing) Need for a framework PMH difficult to define as it would ideally embrace notions of both good and poor mental health within its scope Relation of concepts to one another Rose and Day (1990) Continuously measured health variables Prominence to population-wide approaches Child mental disorders represent the extreme end of a distribution rather than a category that is distinct from the normal range A population s mean symptom score predicts the prevalence of disorder Determinants of average mental health should be investigated Implementation of population-wide interventions alongside more targeted approaches should be considered (Goodman and Goodman 2010) A very small shift in the population mean of the underlying symptoms or risk factors can do more to enhance wellbeing and reduce disorder than would any amount of intervention with individuals who need help (Huppert 2009) CMO (2014) evidence for interventions that shift the curve haven t been forthcoming Wellbeing-primary prevention of mental disorder as described in the Foresight report?

19 Correlation WEMWBS and SDQ scales SDQ 10 TDS r= WEMWBS (overall score) SDQ_TDS Fitted values 95% CI

20 Confounders (DAG model)

21 Physical activity Mean counts per minute (cpm) 0 Number of participants Mean daily MVPA minutes

22 Emotional wellbeing WEMWBS overall score (14-70) 0 Number of participants SDQ TDS (0-40)